How to Prevent Overdose Deaths—and How Not To

The Trump administration wants to do more of what hasn’t worked.

In the next 24 hours, we can expect that some 200 Americans will die of drug overdoses. The relentless toll is the equivalent of the 9/11 attacks occurring every 15 days. Drug laws and enforcement have proved spectacularly ineffectual at saving lives.

So the Trump administration has a novel idea: Do more of what hasn't worked. It's reminiscent of the old line: "The floggings will continue until morale improves."

Illicit opioid users often die of overdoses because, in an unregulated black market, they can't be sure of what they are purchasing. As a result, they sometimes unwittingly inject more than their bodies can tolerate. They also die because they use drugs in places where there is no one to help if they stop breathing.

Public health experts have devised a way to address these problems. "Supervised consumption sites" are spaces where people can obtain sterile syringes and inject drugs in the presence of medical personnel who can save them if they overdose. They can also get referrals for treatment.

Several cities, including Philadelphia, New York, and San Francisco, have moved toward opening such facilities. But the Justice Department is threatening to marshal its powers against them.

Deputy Attorney General Rod Rosenstein took to the opinion page of The New York Times to denounce the approach. He told a radio interviewer that if the city of Philadelphia proceeds with plans for such a facility, the federal government will act to stop it. "Americans struggling with addiction," he wrote, "do not need a taxpayer-sponsored haven to shoot up."

His argument is worth considering because it reflects both administration policy and the prevailing outlook among defenders of the status quo. But it's a model of confusion and deceit, exhibiting a disregard of pertinent evidence.

He says these sites "actually create serious public safety risks" because "users often have no idea what they are actually buying from criminal drug dealers." That's not an argument against such facilities; it's an argument for them.

If you don't know what you're putting into your arm, the chance of an overdose is especially high. These facilities can test drugs for fentanyl, a synthetic opioid that is far more powerful than heroin. Having a nurse on hand to monitor your condition can be the difference between dying from the bad drugs and surviving.

To Rosenstein, this option amounts to "facilitating illicit drug use" and signaling that "the government thinks illegal drugs can be used safely." His alternative is to keep illegal drug use as dangerous as possible, in the earnest hope of deterring people from getting high.

But punitive policies have been tried, with disastrous consequences. The number of drug offenders behind bars is 12 times higher today than in 1980, but illegal drug use has risen steadily over the past two decades. The number of fatalities from drug overdoses has doubled since 2008 and quadrupled since 2000.

Rosenstein claims that under this president, "prosecutions of drug traffickers are on the rise, and the surge in drug overdose deaths is slowing." What he omits is that the number of overdose deaths rose by about 8,000 last year.

He faults supervised sites because most patrons don't get treatment. But a study in the American Journal of Public Health found that clients in Sydney, Australia, and Vancouver, British Columbia, were far more likely to enter treatment than drug users who stayed away.

Rosenstein claims that these operations bring "violence and despair, posing a danger to neighbors." Wrong again. The same study detected "no negative effects on the surrounding community."

You can't get people into treatment or off drugs unless you can keep them alive. That's the main function of these facilities. Epidemiologist Alex Kral of RTI International, a North Carolina research institute, told The Washington Post that over 30 years in Europe and 15 years in Canada, none has had a single overdose death.

By furnishing clean needles and encouraging safe practices, the centers have also curbed the transmission of HIV, hepatitis, and other diseases. If Rosenstein is truly concerned about the burden on taxpayers, he should consider the costs of drug-related illnesses and overdoses. A study in the Canadian Medical Association Journal found that the Vancouver facility has yielded a net savings of $20 million over a decade.

That's the evidence of how effectively supervised consumption sites work. And if you want evidence of the failure of existing policies to prevent overdose deaths, it just keeps coming—200 times a day.

Steve Chapman is a columnist and editorial writer for the Chicago Tribune.

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I spent years in the drug abuse prevention, and mental health treatment fields. The current administration has no real interest in either. This is a public heath issue, and should be treated like one. Professionals know how, all they need is the tools.

Eh, simply putting drug overdoses under the specter of "public health" doesn't mean freewheeling acceptance of every proposal. More people will die from heart disease and yet no calls for supervised consumption sites for double bacon burgers.

This has the same feel as when China White was introduced and the gnashing of teeth that followed. As I recall more accessible testing methods ultimately turned the tide (as well as cheaper more interesting drugs coming into vogue). And if we are being honest, drug treatment success rates are abysmal. Glorified witch doctors isn't really a health policy inasmuch as burnt offerings to the gods of addiction.

People are free to pursue all manner of risky behaviors from wingsuits to national politics. This is the worst of nanny statism covering for the failed nanny statism of drug policy. Fix the underlying issue and have narcan more readily available, but much more beyond that and you are harshing my buzz with your attempts to save my soul.

"Eh, simply putting drug overdoses under the specter of "public health" doesn't mean freewheeling acceptance of every proposal. More people will die from heart disease and yet no calls for supervised consumption sites for double bacon burgers."

Drug addiction is not public health unless you actually need to deal with public health.

Heart disease has been dealt with on that level since it was known.

Freewheeling acceptance has not been proposed by anyone here.

Here is a proposal.

Close the Emergency Department and EMS. All of them. You wish to come in prove ability to pay in advance.

"Drugs and the Mind" by DeRopp was the Haight-Ashbury handbook against poisoning. Every trip outside for groceries involved "the game." The game was to try to memorize the list of drugs black market hawkers offered. Hardly anybody tried to sell opiates because customers preferred acid and grass--and had a choice. Uncoerced choice within that free-marketeering hippie redoubt was what protected us from death by opiate overdose, cirrhosis of the liver and car wrecks. Portugal decriminalized ALL drugs and the same outcome repeated there. See graph: https://preview.tinyurl.com/yc72nyyt

Illicit opioid users often die of overdoses because, in an unregulated black market, they can't be sure of what they are purchasing. You can't get people into treatment or off drugs unless you can keep them alive.

Wow, the typical authoritarian reasoning: it's the government's job to prevent people from killing themselves through regulation. I.e., when violating people's individual liberties has some societal benefit, Chapman thinks totalitarianism is OK.

Regulation doesn't have to come directly from government. Simply legalizing the sale and use of drugs would result in market regulation, because it would be out in the open. As it is, someone can't take a dealer to court if they commit fraud. The customer has to roll the dice. Maybe they get what they are asking for, maybe they don't. And if they don't they might die. If that happened in a legal market, the seller would be sued, blued and tattooed. Before long only reputable dealers who regulate their product would remain. Wouldn't need government rules other than no force or fraud.

Typical moron's reasoning in your comment. It IS and should be the government's job to prevent people from killing themselves, whether with drugs or a pistol. I can't imagine why any decent person would think otherwise. BTW, what Chapman thinks is hardly totalitarianism, and your use of the term shows how truly ignorant you are of both drug problems and governmental systems.

Mark22: This isn't about the government preventing people killing themselves, but about the government ceasing to _cause_ people to die.

In the 1920's, Prohibitionists added deadlier poisons to denatured alcohol (used in many industrial processes and cleaning operations) lest someone succeed in removing the poison and getting buzzed without dying or going blind. In the 1960's, they sprayed suspected marijuana crops with Paraquat, to turn one of the least harmful drugs ever discovered into a poison. They were forced by public demand to cease jailing users to "protect" them, but whenever possible they'd write the law to presume that someone carrying "too much" was a dealer rather than a user, and set a rather low quantity as the threshold. During the AIDS epidemic, they made it illegal to supply addicts with sterile needles. They are now losing public support, but fighting a rear-guard action to keep drug use as dangerous as possible, at the same time they are practicing medicine without a license in regards to prescription pain-killers.

In summary, no form of Prohibition has ever been about protecting the users - it always becomes a campaign to punish those who flout their authority, preferably by killing them.

Yes, the "stop arranging society" must have been the giveaway. Well known socialist trait.

You didn't say "we should stop arranging society, period", you said "we could stop arranging society for our own personal benefit", which is in fact a mainstream socialist belief, implying that "we should instead arrange society for the benefit of the community".

"Supervised consumption sites" are spaces where people can obtain sterile syringes and inject drugs in the presence of medical personnel who can save them if they overdose. They can also get referrals for treatment."
~◔^◔~
This is 100% nonsense. All one needs to do is check out the "progressive" European cities who have embraced this failed, enabling concept. It's death on two wheels.
We who have indulged in such death-fostering substances over the years (in my case in my errant youth) know full-well that legalizing this behavior is contrary to the public weal. While a supporter of legalizing marijuana since the 1960s, I suggest that legalizing anything else is pure societal suicide - Thanatos - not that anyone cares.
"As he comes ... he goes". BTW - Ditch the Narcan (Naloxone) and let the laggards fend for themselves.
Finally ... That Fentanyl is coming from Communist China for a reason my fellow informed Americans.

I can see both sides. I think one is rooted in good intentions and the other in reality. The people with good intentions want to eliminate the stuff as best as they can so they can stop people from making bad decisions. The ones rooted in reality accept that people will do stupid things, and figure there's no use in trying to stop them.

The result of good intentions is that people continue to do stupid things. Making it illegal does make it less available, but people can still find it. Because it is a black market, people end up settling disputes with violence. Those who enforce the good intentions do so with violence. No courts are available, and it's hard to figure out who is responsible anyway. So you get lots and lots of violence. That doesn't count the dead bodies from bad product, and the people rotting in cages. What's that expression about the road to Hell?

The result of accepting reality is that people continue to do stupid things. Being legal it will be easier to obtain. However in a legal environment, people can use the courts rather than sucking it up or resorting to violence when there is a problem. It is easier to hold people accountable because it is done in the open.

Thomas Sowell is very intelligent, but he is wrong here, as are you. And the paving you speak of to Perdition is "good intentions". This is just a little too cute, unless the same road is what you'd call people who give the homeless food. Surely, this won't cause there to be a drop in the number of homeless, but it will cause a drop in starvation. Think before you post.

Why don't YOU check out Portugal which decriminalized all drugs years ago and has use and deaths decline. Also who the fuck are you to tell another human what they can do with their own bodies you statist piece of shit.

Fuck the public weal, to death.
Individual well-being, as chosen by the individual [& no force, fraud, aggression] is all that exists as first-class 'stuff'.
The so-called public weal is a derivative, not a primary.
Individuals benefit or suffer harm, aggregates do not as such.

"Public health experts have devised a way to address these problems. "Supervised consumption sites" are spaces where people can obtain sterile syringes and inject drugs in the presence of medical personnel who can save them if they overdose. They can also get referrals for treatment."

Lets put one in Steve Chapman's neighborhood! His kids can play in streets where the homeless camp and frolic in parks where hypodermic needles and human feces can be found. Who would say no to such a grand proposition?!?

Why not legalize everything and let all these dipshits kill themselves? Let city governments and private businesses legislate where they can and cannot do this crap so they can all go buy it in one corner of the city and shoot it up there away from all the people that do not like seeing crazed, high, homeless people everywhere?

I was expecting to be miffed by finding myself in agreement with the chap man, but I shouldn't have worried. I havent been approved as a legitimate speaker for libertarianism, so this should be taken with an appropriate amount of salt, but it seems to me the range of opinions that could correctly be called "libertarian" starts and ends at disillegalization.

Ending prohibition would improve a number of things: overdoses, gang violence (above and below the border decreasing refugees trying to escape it), drug fishing expeditions by the cops which will decrease police/citizen interactions aka police shootings, lives destroyed by imprisonmemt and arrest records that destroy hope for the future, as with alcohol ending prohibition will most likely make it more difficult, not easier for minors to obtain drugs. Then of course there are massive resources wasted on the WOD.

Once you start utilitarian arguments for drug legalization, you've already lost because you've already admitted to a utilitarian framework in which to decide policy; and progressives are going to find more experts to certify their beliefs than you are ever going to find for yours.

The only argument for drug legalization from a libertarian point of view is that drug laws are a violation of individual liberties. Whether legalization has benefits or costs to society or individuals is irrelevant.

The only argument for drug legalization from a libertarian point of view is that drug laws are a violation of individual liberties. Whether legalization has benefits or costs to society or individuals is irrelevant.

And I'm sure you can do an excellent job of convincing all of the other libertarians with that argument. I, in fact, totally agree with it.

Now, how are you going to convince the 97% of people who don't vote libertarian, don't hold libertarian values, and don't use libertarian philosophies to make their decisions that they should agree to legalization?

You point out that it's going to lower their taxes, get the needles out of the parks their kids play in, reduce the fear they feel every time they spot a cop in the rearview mirror even though they know they're clean, and so on.

Personally, I don't actually give a fuck why the drug war ends. I just want it to end.

Now, how are you going to convince the 97% of people who don't vote libertarian, don't hold libertarian values, and don't use libertarian philosophies to make their decisions that they should agree to legalization?

You convince them of the value of libertarian principles.

Personally, I don't actually give a fuck why the drug war ends. I just want it to end.

You are unlikely to win the argument against the drug war that way, and by agreeing to utilitarian principles, you've pretty much given up on all the other progressive, statist issues.

Yeah, I think you're going to have a lot better luck arguing their pocketbook, but you do you.

I doubt it. Progressives are voted for by three groups: the very poor, the very wealthy, and government employees. Progressive policies are carefully designed to appeal to work in the financial self-interest of these groups; you're not going to convince them with "their pocketbook" because they are already maximizing that.

In the case of the war on drugs, it benefits government employees a lot, the very wealthy don't care, and the majority of the very poor don't want drugs in their neighborhoods.

Well, even if I'm wrong, if I've tried the libertarian position, and that hasn't worked, I don't really lose anything by appealing to their sense of self-interest. And if that doesn't work either, all I'm out is the gum flapping.

The injection centers are not to provide any sort of cure or solution to IV drug addiction.

The idea is to address a public health and safety problem and is limited in scope. It only applies those places where you have a concentrated population of addicts, many homeless, who are hanging out and using in the area. There is risk with HIV, Hepatitis, sanitation issues, and other infections.

This does not nearly include the entire population nor does it address treatment for those who want to stop. They do refer to treatment centers but that is something else.

If a proposal to have such a center is funded it needs to prove that it has made enough impact to justify the cost. Results in Toronto might be very different in Philadelphia.

There are many facets to the opiod addiction problem. It needs to be addressed on a rational evidence based level. What Rosenstien said is emotional gibberish. As always when it becomes political all reason goes out the door.

The REALLY simple solution would be for the FedGov to stop trying to control what substance(s) a consenting adult may or may not wish to introduce into their tender bodies by whatever means they choose. Try as I may, I have never been able to find a part of Article I, Section 8 which empowers congress to legislate on what substance(s) an adult may use. I do not personally use drugs recreationally but I believe that consenting adults should be able to do so if they choose. So long as what my neighbor does in his backyard "neither picks my pocket nor breaks my leg" he is entirely welcome to do what he pleases. So long as what my neighbor does in his backyard doesn't slop over into mine we have no problem. If what my neighbor does in his backyard DOES slop over into mine THEN we have a problem.

Would this possibly result in deaths by overdose? Certainly. But then if "my body; my choice" is meaningful then shouldn't adults have the choice to muck up their bodies however they choose?

While the government shouldn't be stopping privately funded drug dens, at the same time, any time you see something like "public health experts", it's a very short line to government funding.

Which is worse than drug addicts ODing. I mean, it's not like the 9/11 comparison you make so glibly, that was an attack by foreign nationals who want to impose totalitarianism upon the entire world, including the US.